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Annexure I

Customer Declaration For Handling Third Party Remittances / Documents


(To be obtained from the Exporter on the Company’s Letterhead)

To
The Branch Head
Axis Bank Ltd

Dear Sir/Madam,
We, hereby declare and confirm that the shipment in respect of the

following remittance received through Axis Bank towards export of goods / services has
been made by us. The details of the shipment made by us are also specified below:

1 Inward remittance amount


and date/Export Bill
Reference No. and date
2 Name & address of Buyer
3 Name & country of the
Remitter
4 Currency and Amount
5 Description of goods
6 Port of Loading
7 Port of Discharge
8 Shipping Bill No. and Date
9 AWB / BL No. & Date
10 Invoice No. and Date
11 In case of Software export,
types of Software Exported
12 Reason for receiving the
payment from Third Party

2. In consideration of Axis Bank accepting and relying on the aforesaid details and
enclosures, we confirm, agree, declare and undertake that:

i. The goods being exported are in commensurate with our line of business.
ii. There is a bonafide trade relationship between the buyer and the remitter.
iii. We do not figure in RBI Caution List, Specific Approval List (SAL) of ECGC and that we
are/were not under any investigation by the Regulator/Law Enforcement Agency. In
the event we are/were under any such investigation, Axis Bank reserves the right to
seek any detail(s)/copy(ies) of the investigation from us and we shall promptly
provide the same upon notice.
iv. We shall furnish any material evidence/information relating to the above transaction
as required by any authority/government agency, Axis Bank, now or in future. We,
further authorise Axis Bank to make available any of the material
evidence/information pertaining to the above transaction to any
authority/agency/entity/ regulator without referring the matter to us.

v. We shall not hold Axis Bank Limited liable or responsible in any manner whatsoever in
nature and agree and undertake to indemnify and keep at all times indemnified Axis
Bank, its successors and assigns in business against all losses, charges, claims,
demands, litigations and such other cost(s) (including reasonable legal counsel fees)
that may be incurred or suffered by Axis Bank as a result of the above transaction
and/or on account of relying on this declaration and enclosures provided by us.

vi. We shall indemnify Axis Bank Limited against any penalty if any levied by any
authority/government agency, regulator in relation to the above transaction; and

vii. We shall pay and make good any such losses, charges, claims, demands, and such
other cost or expense immediately upon demand being made by Axis Bank.

Thanking You,
For (name of firm / company)

Authorised Signatory.

Date:
Place: